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The Case for Whole-Person Integrative Care.

ABSTRACT: Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for "Whole Health Veterans Administration," "integrative medicine," "integrative health," "complementary and alternative medicine," and, as they related to the outcomes, of "health outcomes," "cost-effectiveness," "cost reduction," "patient satisfaction," and "physician satisfaction." Additional studies were identified from an initial search and the authors' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.

SUBMITTER: Jonas WB

PROVIDER: S-EPMC8307064 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:AIM:The aims of this literature review were to better understand the current literature about person-centred care (PCC) and identify a clear definition of the term PCC relevant to nursing practice. METHOD/DATA SOURCES:An integrative literature review was undertaken using The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Scopus and Pubmed databases. The limitations were English language, full text articles published between 1998 and 2018 within Australian, New Zealand, Canada, USA, Europe, Ireland and UK were included. The international context off PCC is then specifically related to the Australian context. REVIEW METHODS:The review adopted a thematic analysis to categorise and summarise themes with reference to the concept of PCC. The review process also adhered to the Preferred Reporting System for Meta-Analysis (PRISMA) and applied the Critical Appraisal Skills Programme (CASP) tools to ensure the quality of the papers included for deeper analysis. RESULTS:While definitions of PCC do exist, there is no universally used definition within the nursing profession. This review has found three core themes which contribute to how PCC is understood and practiced, these are People, Practice and Power. This review uncovered a malalignment between the concept of PCC and the operationalisation of the term; this misalignment was discovered at both the practice level, and at the micro, meso and micro levels of the healthcare service. CONCLUSION:The concept of PCC is well known to nurses, yet ill-defined and operationalised into practice. PCC is potentially hindered by its apparent rhetorical nature, and further investigation of how PCC is valued and operationalised through its measurement and reported outcomes is needed. Investigation of the literature found many definitions of PCC, but no one universally accepted and used definition. Subsequently, PCC remains conceptional in nature, leading to disparity between how it is interpreted and operationalised within the healthcare system and within nursing services.

Project description:IntroductionThe concept of personhood is particularly important in person-centred dementia care because its overall aim is to maintain the personhood of people living with dementia despite disease progression. In a previous review on autonomy for people with dementia, two different underlying concepts of personhood were identified: a rationalistic and a social constructionist concept of personhood. The present integrative review aims to (1) identify existing theoretical approaches in person-centred dementia care, (2) describe the constitutive components for these theoretical approaches, (3) report the goals and/or outcomes to be achieved by person-centred care for people living with dementia and (4) identify the underlying concepts of personhood.Methods and analysisFor our integrative review the search terms were derived from the research questions and clustered according to the 'PICo' (Population, Interest, Context) framework. A systematic literature search for theoretical approaches of 'person-centred dementia care' will be performed on MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). The title/abstract and full-text screening will be performed independently by two researchers according to the inclusion criteria. The data analysis procedure will have two steps: (1) identification and extraction of general information (e.g., type of publication and name of theoretical approaches described) and (2) a qualitative content analysis to analyse the components, goals, outcomes and understanding of the respective underlying conceptions of personhood within the theoretical approaches. The extraction of general information (e.g., authors) will be performed by one researcher and qualitative content analysis will be performed independently by two researchers using MAXQDA software. Any disagreements will be resolved through discussion between the two researchers or, if no consensus can be reached, with all coauthors.Ethics and disseminationDue to the nature of a review, ethical approval is not required. We will disseminate our results in peer-reviewed journals and at (inter)national conferences.

Project description:ObjectivesThe importance of 'whole person' or 'holistic' care is widely recognised, particularly with an increasing prevalence of chronic multimorbidity internationally. This approach to care is a defining feature of general practice. However, its precise meaning remains ambiguous. We aimed to determine how the term 'whole person' care is understood by general practitioners (GPs), and whether it is synonymous with '[w]holistic' and 'biopsychosocial' care.DesignSystematic literature review.MethodsMEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Proquest Dissertations and Theses, Science.gov (Health and Medicine database), Google Scholar and included studies' reference lists were searched with an unlimited date range. Systematic or literature reviews, original research, theoretical articles or books/book chapters; specific to general practice; relevant to the research question; and published in English were included. Included literature was critically appraised, and data were extracted and analysed using thematic synthesis.ResultsFifty publications were included from 4297 non-duplicate records retrieved. Six themes were identified: a multidimensional, integrated approach; the importance of the therapeutic relationship; acknowledging doctors' humanity; recognising patients' individual personhood; viewing health as more than absence of disease; and employing a range of treatment modalities. Whole person, biopsychosocial and holistic terminology were often used interchangeably, but were not synonymous.ConclusionsWhole person, holistic and biopsychosocial terminology are primarily characterised by a multidimensional approach to care and incorporate additional elements described above. Whole person care probably represents the closest representation of the basis for general practice. Health systems aiming to provide whole person care need to address the challenge of integrating the care of other health professionals, and maintaining the patient-doctor relationship central to the themes identified. Further research is required to clarify the representativeness of the findings, and the relative importance GPs' assign to each theme.Prospero registration numberCRD42017058824.

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The Case for Whole-Person Integrative Care.

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